Possible Impact of Measures to Curb COVID-19 Spread on Suicide Prevention Efforts
Social distancing and other public health actions intended to curb the spread of COVID-19 have the potential for adverse outcomes on suicide risk. Economic downturns are often associated with higher suicide rates compared to periods of prosperity and people may be experiencing fears that canceled events and closed businesses will lead to a recession. Leading theories of suicide emphasize the key role of social connections in suicide prevention, so the critical public health strategy of social distancing is concerning. In addition, attendance at religious services has been associated with lower suicide rates, so the effects of closing churches and community centers may further contribute to social isolation. Real or perceived barriers to mental health access (inability to attend an appointment due to children home from school) may negatively impact patients with suicidal ideation and exacerbated physical health problems could increase suicide risk for some patients. Despite these challenges, there are opportunities to improve suicide prevention efforts during this time:
- Social distancing requires physical space between people, but efforts can be made to stay connected by telephone or video, especially for individuals with substantial suicide risk factors. Of note, suicide rates have declined after past national disasters (e.g. 9/11 attacks), perhaps due to the “pulling together effect,” where a shared experience strengthens social connectedness.
- Increase access to suicide prevention interventions that were designed to be delivered remotely, such as telephone-based outreach and the Caring Letters intervention, in which letters are sent through the mail.
- Follow up with individuals who are positive for COVID-19 and have suicide risk factors.
- Concerns about negative secondary outcomes of COVID-19 prevention efforts should not imply that that these public health actions should not be taken. However, implementation should include a comprehensive approach that considers the public health priority of suicide prevention as well.
Dr. Reger is Chief of Psychology Services at the VA Puget Sound Health Care System and part of HSR&D's Center of Innovation for Veteran-Centered and Value Driven Care.
Reger M, Stanley I, Joiner T. Viewpoint: Suicide Mortality and Coronavirus Disease 2019 – A Perfect Storm? JAMA Psychiatry. April 10, 2020; Epub ahead of print.